Carlos Sánchez Juan

VALORACIÓN DE UN PROGRAMA DE EJERCICIO FÍSICO ESTRUCTURADO EN PACIENTES CON OBESIDAD MÓRBIDA PENDIENTES DE CIRUGÍA BARIÁTRICA

INTRODUCTIONnObesity is a chronic disease whose prevalence is increasing up to be considered a real epidemic. In the case of morbid obesity, in many cases required to resort to surgery to achieve adequate weight reduction and improvement of comorbidities. There are, however, few studies have evaluated the influence of a structured program of physical exercise in these patients before surgery.nnnOBJECTIVEnTo evaluate the influence of a structured program of physical exercise in morbidly obese patients awaiting bariatric surgery.nnnMETHODnProspective intervention study in 10 patients (6 women and 4 men) morbidly obese bariatric surgery pending of 47.1 ± 4.6 years. Structured exercise program for 2 months (16 sessions) along with food education. It was assessed before and after intervention anthropometric and body composition by bioelectrical impedance, fitness, food habits survey, physical activity, quality of life and satisfaction with the program.nnnRESULTSnWeight loss achieved after the program was 5.17 ± 4.01 kg and BMI of 1.77. There was also a favorable change in body composition with 1.77% increase of muscle mass and decrease of 2.83% and 1.43% in total fat mass and visceral, respectively. The distance traveled as an expression of the physical condition of the subjects improved significantly going from 586.72 ± 82.8 m to 625.59 ± 78.2 m. No significant differences in the assessment of quality of life, adherence to the program was 75% and the degree of satisfaction with it was very high.nnnCONCLUSIONSnA structured program of physical exercise in morbidly obese patients awaiting bariatric surgery helps in reducing weight and improving body composition while increasing fitness and is well accepted by patients, so it can be a part of the multidisciplinary approach to this disease.

Evaluación organoléptica de suplementos de nutrición enteral

INTRODUCTION AND OBJECTIVESnEnteral nutrition (EN) is indicated in patients who, although they may not eat enough food, maintain a sufficient function to receive, digest and absorb nutrients digestive system. Oral Nutritional Supplements (SON) are nutritionally complete or incomplete formulas (depending on whether or not provide all the nutrients needed to serve as the sole source of nutrients), which supplement inadequate oral diet. This study aims to evaluate the organoleptic characteristics of hyperproteic, normoproteic and fiber-enriched oral SON.nnnMATERIAL AND METHODSnSON test, carried out at the Department of Endocrinology and Nutrition Consortium Hospital General Universitario de Valencia from October 2012 to February 2013. 137 SON were evaluated in total, of which 47 were hyperproteic, 46 normoproteic and 44 enriched in fiber.nnnRESULTSnOf the SON evaluated in the group of hyperproteic the following 3 SON obtained the best scores: Fresenius Prot Energy Drink® (21,27, vanilla flavor), Avant Standard Nut® (20.3 , strawberry flavor) and Resource® Protein (20.01, chocolate flavor) In the group of normoproteic SON the 3 best rated were: Ensure Plus® (22.3, banana flavor), Ensure Plus® (21.9, peach flavor) and Fresubin Energy Drink® (21, strawberry flavor) In the group of fiber-enriched the 3 SON most appreciated were: 2 Kcal Fresubin Fibre Drink® (23.78, vanilla flavor), Ensure Plus® TwoCal (22.9, banana flavor) and Fortimel Compact® (21.5, strawberry flavor)nnnCONCLUSIONSnThe study aims to guide clinicians on what SON may be more acceptable to the patient, so that the SON serve their purpose and restore or improve nutritional status, as the SON intervention is safe and cost - effective, since they improve both the functionality and quality of life.

Sensory evaluation of enteral nutritional supplements

INTRODUCTION AND OBJECTIVESnEnteral nutrition (EN) is indicated in patients who, although they may not eat enough food, maintain a sufficient function to receive, digest and absorb nutrients digestive system. Oral Nutritional Supplements (SON) are nutritionally complete or incomplete formulas (depending on whether or not provide all the nutrients needed to serve as the sole source of nutrients), which supplement inadequate oral diet. This study aims to evaluate the organoleptic characteristics of hyperproteic, normoproteic and fiber-enriched oral SON.nnnMATERIAL AND METHODSnSON test, carried out at the Department of Endocrinology and Nutrition Consortium Hospital General Universitario de Valencia from October 2012 to February 2013. 137 SON were evaluated in total, of which 47 were hyperproteic, 46 normoproteic and 44 enriched in fiber.nnnRESULTSnOf the SON evaluated in the group of hyperproteic the following 3 SON obtained the best scores: Fresenius Prot Energy Drink® (21,27, vanilla flavor), Avant Standard Nut® (20.3 , strawberry flavor) and Resource® Protein (20.01, chocolate flavor) In the group of normoproteic SON the 3 best rated were: Ensure Plus® (22.3, banana flavor), Ensure Plus® (21.9, peach flavor) and Fresubin Energy Drink® (21, strawberry flavor) In the group of fiber-enriched the 3 SON most appreciated were: 2 Kcal Fresubin Fibre Drink® (23.78, vanilla flavor), Ensure Plus® TwoCal (22.9, banana flavor) and Fortimel Compact® (21.5, strawberry flavor)nnnCONCLUSIONSnThe study aims to guide clinicians on what SON may be more acceptable to the patient, so that the SON serve their purpose and restore or improve nutritional status, as the SON intervention is safe and cost - effective, since they improve both the functionality and quality of life.

Glomerulosclerosis nodular diabética sin diabetes mellitus conocida previamente

La nefropatia es una de las complicaciones cronicas de la diabetes mellitus relacionadas con un incremento de la morbimortalidad en la poblacion afectada. Puede detectarse tras varios anos de evolucion de la enfermedad en el caso de la diabetes tipo 1, al poco tiempo del diagnostico en la diabetes tipo 2 e incluso al inicio de esta, y es muy infrecuente sin diabetes mellitus previamente conocida. Presentamos 2 casos de nefropatia diabetica en pacientes sin historia previa de diabetes mellitus. Uno de ellos fue diagnosticado posteriormente de intolerancia a los hidratos de carbono. En el otro, el estudio del metabolismo hidrocarbonado fue normal. Se revisa la bibliografia y se discute sobre los mecanismos geneticos y ambientales implicados en el desarrollo de la intolerancia. Se discute tambien la importancia de incluir la nefropatia diabetica en el diagnostico diferencial de la glomerulosclerosis nodular, incluso en casos sin diabetes mellitus previamente conocida.

Consumo de frutos secos y aceites vegetales en personas con diabetes mellitus tipo 1

INTRODUCTIONnRecent studies have demonstrated the cardiovascular benefits of the Mediterranean Diet, enriched with olive oil and nuts. People with diabetes, who have an increased risk of cardiovascular complications, could benefit greatly from following this type of eating pattern.nnnOBJECTIVEnAnalysis of vegetable fats intake from nuts and olive oil in patients with 1 Diabetes Mellitus type (DM1).nnnMETHODSnTransverse descriptive study comparing 60 people with type 1 Diabetes Mellitus (DM1) with 60 healthy individuals. We collect the frequency of consumption of vegetable oils and nuts and calculate the contribution of these foods in mono and polyunsaturated fatty acids (oleic acid, linoleic acid and α-linolenic acid). For data collection we designed a food frequency questionnaire specifically. We also collect anthropometric variables, cardiovascular risk factors and diabetes-related variables.nnnRESULTSnVegetable fat intake from vegetable oils (3.02 ± 1.14 vs 3.07 ± 1.27 portions/day, P = 0.822) and nuts (1.35 ± 2.24 vs 1.60 ± 2.44 portions/week, P = 0.560), was similar in both groups. The DM1 group consumed fewer portions of olive oil daily than the control group (2.55 ± 1.17 vs 3.02 ± 1.34 portions/day, P = 0.046). We detected a significantly lower intake of α-linolenic acid in the control group (1.13 ± 2.06 versus 2.64 ± 4.37 g/day, p = 0.018) while there were not differences in the rest of fatty acids (oleic acid 28.30 ± 18.13 vs 29.53 ± 16.90 g/day, P = 0.703; linoleic 13.70 ± 16.80 vs 15.45 ± 19.90 g/day, P = 0.605). In DM1, it not demonstrated an influence of the intake of vegetable fats and oils from nuts in the anthropometric, metabolic and diabetes-specific variables.nnnCONCLUSIONSnIn people with DM1, total intake of vegetable oils and nuts do not differ from the general population. However, the consumption of olive oil and the contribution of α-linolenic fatty acid derived from such fats are slightly lower than the general population. Although intake of vegetable oils and nuts in people with DM1 is not related to metabolic parameters, or progression of complications of diabetes, it is reasonable to increase their intake, given the recognized benefits of this type of food.

Presentación atípica de tiroiditis aguda supurada en paciente inmunocompetente

Thyroid gland infection is a very uncommon condition, as the thyroid gland is extremely resistant to infection. This has been attributed to its high vascularization, lymphatic drainage, the presence of high iodine levels in tissue, the fact that hydrogen peroxide is generated inside the gland as a requirement for thyroid hormone synthesis, and its normal encapsulated location far from external structures (all of which have bactericidal effects). The most common etiological agents are microorganisms which are able to colonize oral mucosa and continue to the thyroid gland, especially Gram-positive bacteria such as streptococci and staphylococci, or anaerobic bacteria. Despite being unusual, it is a potentially curable disease with an excellent prognosis because of the current availability of antibiotics to cure it. A 57-year-old female patient attended the emergency room for pain and inflammation in the right subacromial region which worsened with arm motion and was associated with progressive dysphagia. She had no infectious signs, nor symptoms of hypothyroidism or hyperthyroidism. She reported no skin lesions. The condition had started one week before with fever up to 39 ◦C, which subsided at two days. Her medical history was unremarkable. A physical examination revealed a right cervical mass extending to the infraclavicular region which was tender, erythematous, and not indurated. Supplemental tests showed 14,600 WBCs, with 87% neutrophils, and a C-reactive protein level of 43.8 mg/dL. Serologic tests for HBV, HCV, HDV, and HIV were negative. Levels of all other parameters, including thyroid hormones, were clinically irrelevant.

Aportación de la tomografía por emisión de positrones al diagnóstico de un caso de acromegalia

Diagnosis of acromegaly is based on biochemical tests demonstrating increased growth hormone (GH) secretion. More than 95% of patients with acromegaly harbor a GH-secreting pituitary adenoma. The technique of choice in the diagnosis of an adenoma is magnetic resonance imaging (MRI). The use of new techniques such as (111)In-octreotide scintigraphy (OctreoScan) and positron emission tomography (PET) can provide additional information in some cases. We report the case of a woman with acromegaly. The results of several MRI scans and OctreoScan were normal and other diagnostic possibilities were ruled out. The pituitary origin of the increased GH secretion was identified by PET. In acromegaly, the absence of MRI findings and identification of location by means of PET are exceptional.El diagnostico de acromegalia esta basado en pruebas bioquimicas que muestran un aumento de secrecion de somatotropina (GH). Mas del 95% de los pacientes con acromegalia presentan un adenoma hipofisario productor de GH. La tecnica de imagen de eleccion en el diagnostico del adenoma es la resonancia magnetica (RM). La utilizacion de nuevas tecnicas, como la gammagrafia con 111 In-pentetreotida (OctreoScan) y la tomografia por emision de positrones (PET), puede aportar informacion adicional en algunos casos. Presentamos el caso de una mujer diagnosticada de acromegalia. Varias RM y el OctreoScan fueron normales y otras posibilidades diagnosticas fueron descartadas. La PET localizo el origen hipofisario de la hipersecrecion de GH. En la acromegalia, la ausencia de hallazgos en la RM y el diagnostico de localizacion por medio de PET son excepcionales.: Diagnosis of acromegaly is based on biochemical tests demonstrating increased growth hormone (GH) secretion. More than 95% of patients with acromegaly harbor a GH-secreting pituitary adenoma. The technique of choice in the diagnosis of an adenoma is magnetic resonance imaging (MRI). The use of new techniques such as (111)In-octreotide scintigraphy (OctreoScan) and positron emission tomography (PET) can provide additional information in some cases. We report the case of a woman with acromegaly. The results of several MRI scans and OctreoScan were normal and other diagnostic possibilities were ruled out. The pituitary origin of the increased GH secretion was identified by PET. In acromegaly, the absence of MRI findings and identification of location by means of PET are exceptional.

Miopatía como presentación infrecuente de acromegalia

La miositis o miopatia inflamatoria es una manifestacion frecuente de la acromegalia, aunque poco estudiada. Se caracteriza por debilidad de predominio proximal que puede acompanarse de dolor muscular. El incremento de las enzimas musculares, la alteracion en el electromiograma y la biopsia compatible son hallazgos que apoyan el diagnostico. Presentamos el caso de una paciente que consulto por debilidad muscular. Los estudios complementarios confirmaron la miositis y, tras descartar otras causas, se llego al diagnostico de acromegalia. La miositis como manifestacion predominante de una acromegalia es excepcional.